Investigating the mechanisms that influence healthcare outcomes in sub-Saharan African countries

[摘要] ENGLISH ABSTRACT: Sub-Saharan Africa experiences some of the poorest health care outcomes inthe world. With the combination of a high burden of disease and a severe lackof resources, the health systems in SSA face immense pressure to perform underdifficult circumstances. The need to drive efficiency and gain an in depthunderstanding of health systems in SSA is thus clear.In order to make improvements to health systems, an understanding ofthe way in which health systems function and the components which they aremade up of and influenced by is required. The complexity of health systems isnot only due to the number of components which make up a health system butdue to the interactions with factors which extend beyond the health system.The significant impact of contextual impacts on the health care outcomes ofan area must be recognised along with the way in which these interact andinfluence a health system. The ability to therefore map the way in whichmechanisms influence health care outcomes over an area as large as SSA isfound to be an inexhaustible task, therefore an approach is developed in orderto facilitate the identification of health care outcome bottlenecks in a specificarea.In order to gain an in depth understanding of factors that make up a healthsystem, an analysis of existing conceptual frameworks of health systems is carriedout. This analysis results in the emergence of nine over arching areas toconsider when analysing a health system; along with five performance measurecategories. A systematic literature review is carried out in order to populate the understandingof health systems in relation to the components identified in termsof a SSA setting. The review considers an extensive array of literature in orderto gain a broad understanding of the factors attributed to influencing healthcare outcomes in SSA.From the analysis of the conceptual frameworks along with the results fromthe systematic literature review, a series of challenges and complexities withinhealth systems are highlighted. In order to address these a number of toolsare investigated to develop a method by which to identify bottlenecks foundin health systems.The recognition of the complexity of health systems and the emphasisplaced on contextual factors is reiterated as the recognition of over archinghealth system factors such as lack of resources is found to be well researchedand recorded. Thus the contribution of over arching health system factors isless valuable than the ability to recognise specific factors.In order to facilitate health care outcome improvements and identify mechanismswhich influence these outcomes, an approach to identify bottlenecks indistrict health systems emerges. The approach consists of the following stages:(i) Select a physical area or location; (ii) Select a health care outcome; (iii)Identify the population at risk; (iv) Interpret available data to identify bottlenecks;(v) Discuss process of care identified as the bottleneck; (vi) Discussfactors relating to the bottleneck identified; and (vii) Identify stakeholders androleplayers to be involved in planning and change management.The approach is seen to contribute to the initiation of interventions as ithopes to identify a point in the health system which needs improvement. Extensiveliterature on planning and implementing interventions exists, thereforethis approach makes no effort to contribute hereto but is a decision makingtool as to where effort in health systems can be directed toward.An illustrative case study is carried out in order to demonstrate the wayin which the approach can be populated and to facilitate the study validation.Subject matter experts are consulted in order to improve upon and approvethe results of the study and the emergent approach.This study makes a contribution by illustrating the complexity of healthsystems and suggests an approach which may be followed in order to facilitatethe identification of mechanisms affecting health care outcomes in specific settings.

[发布机构] Stellenbosch University